A UK-based pilot study of current surgical practice and implant preferences in lumbar fusion surgery

Abstract

Lumbar fusion surgery is an established procedure for the treatment of low back pain. Despite the wide set of alternative fusion techniques and existing devices, uniform guidelines are not available yet and common surgical trends are scarcely investigated.The purpose of this UK-based study was to provide a descriptive portrait of current surgeons' practice and implant preferences in lumbar fusion surgery.A UK-based in-person survey was designed for this study and submitted to a group of consultant spinal surgeons (n = 32). Fifteeen queries were addressed based on different aspects of surgeons' practice: lumbar fusion techniques, implant preferences, and bone grafting procedures. Answers were analyzed by means of descriptive statistics.Thirty-two consultant spinal surgeons completed the survey. There was clear consistency on the relevance of a patient-centered management (82.3%), along with a considerable variability of practice on the preferred fusion approach. Fixation surgery was found to be largely adopted (96.0%) and favored over stand-alone cages. With regards to the materials, titanium cages were the most used (54.3%). The geometry of the implants influenced the choice of lumbar cages (81.3%). Specifically, parallel-shape cages were mostly avoided (89.2%) and hyperlordotic cages were preferred at the lower lumbar levels. However, there was no design for lumbar cages which was consistently favored. Autograft bone graft surgeries were the most common (60.0%). Amongst the synthetic options, hydroxyapatite-based bone graft substitutes (76.7%) in injectable paste form (80.8%) were preferred.Current lumbar fusion practice is variable and patient-oriented. Findings from this study highlight the need for large-scale investigative surveys and clinical studies aimed to set specific guidelines for certain pathologies or patient categories.

Figure 1

Relevance of a patient-specific evaluation and affected spinal segment for the selection of surgical procedure (e.g., fusion or disc replacement surgery) and fusion approach (e.g., anterior or posterior interbody fusion) (n = 32).

Figure 2

Relevance of generic parameters, such as patient evaluation, clinical evidence, implant geometry, price, and manufacturer which may influence the selection of fusion implants (n = 32).

Figure 3

Selection of an endplate geometry of implant by surgeons during fusion surgery procedures (n = 31).

Figure 4

Selection of implant design based on available bone grafting area by spinal surgeons (n = 26).